Radiology practices and radiology coding companies looking for maximum revenue in 2015 are required to understand the new CPT/HCPCS coding updates in radiology medical coding and their impact on reimbursements. The key changes include bundling of two codes into one while those codes are reported frequently in combination and creation of new codes to better define their use. Another critical change is that Medicare started providing reimbursement for Digital Breast Tomosynthesis (DBT or sometimes referred to as 3D Mammography) from 2015 when a code is added-on to digital screening and diagnostic mammography services. However, reimbursement from commercial payers for DBT services is not guaranteed. Let’s take a look into the coding changes in detail.
You can find coding changes to procedures related to diagnostic radiology (Breast Tomosynthesis, Breast Ultrasound, Dual-Energy X-ray Absorptiometry (DXA) and interventional radiology (Cryoablation for Bone and Liver Tumors, Myelography and Vertebroplasty).
Breast Tomosynthesis (3D Mammography)
To indicate DBT services, you may add the following CPT code to the digital screening mammography code (G0202).
- 77063: Screening digital breast tomosynthesis, bilateral
Similarly, you may add the following HCPCS code to the digital diagnostic mammogram codes G0206 (unilateral) and G0204 (bilateral).
- G0279: Diagnostic digital breast tomosynthesis, unilateral or bilateral)
These new add-on codes will be paid despite the regular payment for the screening or diagnostic mammogram. The amount will be adjusted according to the geographic region when Medicare publishes their actual fee schedule. You should analyze mammography volume by payer and the coverage policies of major payers. This will help you to estimate how adding DBT services would impact your practice revenue.
If DBT is performed separately from a full-field digital mammogram, you cannot use the add-on code for DBT. Though you cannot use the following newly-created CPT codes for DBT services in case of Medicare, commercial payers may have this option.
- 77061: Breast tomosynthesis diagnostic, unilateral
- 77062: Breast tomosynthesis diagnostic, bilateral
However, the medical billing methods for commercial payers differ from Medicare. You have to contact all major payers to understand what type of coverage they offer and which codes they utilize to provide coverage for DBT.
There were no CPT codes available to define breast ultrasound irrespective of whether bilateral, unilateral, complete or limited. Two new CPT codes are created to define breast ultrasound in 2015 to define unilateral complete and limited examinations. As per the American College of Radiology, a complete examination refers to an examination that includes all four quadrants of the breast and the retro areolar region as well as the ultrasound examination of the axilla, if performed. The newly created CPT codes for breast ultrasound are as follows:
- 76641: Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete
- 76642: Ultrasound, breast, unilateral, limited
Since both codes are unilateral, you can report either of them once, per breast, per session. You may append the modifier 50 (Bilateral procedure), if medical necessity requires bilateral imaging. Medicare pays for bilateral studies at 150% of the unilateral rate when modifier 50 is applied.
Dual-Energy X-ray Absorptiometry (DXA)
Earlier, two separate CPT codes (77080 and 77082) were required to code for Vertebral Fracture Assessment (VFA) when done in conjunction with a DXA bone density exam. From 2015, these codes are combined into a single code while performed together, which is:
- 77085: Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (for example, hips, pelvis, spine) including vertebral fracture assessment
The following CPT code is used for VFA if it is performed using DXA, but without bone density exam.
- 77086: Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA)
Cryoablation for Bone and Liver Tumors
Until now, percutaneous ablation of bone and liver tumors were reported using unlisted codes, which were never the best option. Two new CPT codes are created for reporting these conditions in 2015 such as:
- 20983: Ablation therapy for reduction or eradication of 1 or more bone tumors (for example, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; cryoablation
- 47383: Ablation, 1 or more liver tumor(s), percutaneous, cryoablation
The existing code 20982 for percutaneous radiofrequency ablation therapy is revised to include adjacent soft tissue when involved by tumor extension and imaging guidance. There is a negligible increase in reimbursement for this code also.
New bundled codes created for myelography to use from 2015 include the lumbar injection for which a separate code was used before. The new codes are as follows:
- 62302: Myelography via lumbar injection, including radiological supervision and interpretation; cervical
- 62303: Myelography via lumbar injection, including radiological supervision and interpretation; Thoracic
- 62304: Myelography via lumbar injection, including radiological supervision and interpretation; Lumbosacral
- 62305: Myelography via lumbar injection, including radiological supervision and interpretation; of two or more regions (for example, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)
You can use only these codes when the same physician performs the injections as well as the radiologic interpretation of the exam. If two physicians are performing the procedure (one physician performs the injection and the other provides the radiological supervision and interpretation), the current injection code (62284) and radiologic supervision and interpretation codes (72240, 72265 and 72270) for myelography should be used. The injection code was revised to indicate it is used for reporting an injection procedure in the lumbar spine. Earlier, it was used to indicate an injection for any part of the spine, except for C1-C2 and posterior fossa.
For 2015, three new vertebroplasty and three new vertebral augmentation (kyphoplasty) codes are issued. These codes bundle imaging guidance with the procedure. The new codes are:
- 22510: Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic
- 22511: Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral
- +22512: add-on for each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)
- 22513: Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (for example, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic
- 22514: Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar
- +22515: add-on for each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)
The old procedure and imaging guidance codes are longer available for use now.
There has been a significant change in CPT/HCPCS coding for radiology procedures. It is really a challenging task for radiology practices to keep up with the new changes and maximize their practice revenue. They may either train their billing staffs or seek reliable medical billing and coding services to reduce claim errors and delayed reimbursement. In addition to this, they should have a clear understanding about how each major payer assigns prices for the new codes. Sometimes, they may have to negotiate for these codes. An expert’s service is indispensable in these situations.